The Facts

Sunburn is a kind of radiation damage done by the sun. It's by far the most common form of radiation damage. While most people know radiation is dangerous, they voluntarily expose themselves to the harmful ultraviolet (UV) light of the sun on a regular basis.

Radiation can provoke cancer, and the popularity of sunbathing has brought a steady climb in new cases of skin cancer and actinic keratosis, a precursor to skin cancer. Actinic keratosis and all types of skin cancer, particularly nonmelanoma types (basal and squamous cell cancer), are directly linked to sun exposure. Exposure in early life is especially relevant. Many people get the bulk of their sun exposure during childhood, and it's been shown that even one childhood sunburn increases the risk of developing skin cancer later in life. However, sunburn is not required to damage skin. A tan is also clear evidence of UV skin damage.

In Canada, skin cancer is still fairly rare in people under 40. The amount of UV radiation is more variable in northern than southern latitudes, so the total dose received accumulates more slowly. In Australia, where people are exposed to far more UV light from an early age, skin cancer is a disease that more often strikes people in their 20s and 30s.

The depletion of the ozone layer has raised the degree of exposure, but not by as much as sun-worshipping habits. Regardless, the extra cancer cases from the ozone effect mostly haven't had time to develop yet.

If it weren't for skin cancer, sunburn would be a minor health problem, with only the most extreme cases requiring hospital treatment. As it is, any sun or other UV exposure, including a gentle tan, increases the risk of skin cancer.

Causes

The Sun, like any star, emits vast quantities of energy across a range of wavelengths. The light that's visible to us is only a small fraction of this energy. The human eye can only perceive electromagnetic radiation with wavelengths between 400 nanometres and 700 nanometres (nm), which is called visible light. Violet light at 400 nm wavelength and red light at 700 nm are the upper and lower boundaries of our ability to see radiation. A lot of the energy emitted by the Sun is shorter-wave, more powerful radiation, most of it in the form of ultraviolet (UV) light. UV light's place on the electromagnetic spectrum is immediately above the most energetic form of visible light, which is violet.

UV is classified into 3 degrees of energy, UVA, UVB, and UVC. UVC has the shortest wavelength and the most energy, but it doesn't reach the Earth's surface because it's stopped by the Earth's atmosphere. UVA has the longest wavelength and the least energy and UVB light is between the 2 in wavelength and energy. Longer wavelengths can sometimes be more penetrating than shorter wavelengths, despite having less energy. Of all the UV light that reaches the Earth, about 95% of it is UVA. Because it has the least energy, it's less likely to burn skin than UVB, but because there's so much of it, it plays a part in most sunburns.

Just as UVA penetrates the atmosphere better than more potent UVB and UVC, it also penetrates deeper into the skin. On a microscopic scale, UVA light is more likely than UVB to penetrate the upper skin layers and reach the basal skin layer where it is absorbed. Although it's 1,000 times less potent than UVB, UVA exposure is believed by many experts to be more relevant to wrinkling and aging of the skin, and possibly to skin cancer.

Symptoms and Complications

When UV radiation strikes the body, the skin cells react immediately. Specialized cells produce melanin, the body's defence against UV radiation. People with naturally dark skin have more melanin and more melanin-producing cells. When light-skinned people are damaged by UV radiation, these cells produce more of this dark substance, creating a tan.

With higher levels of exposure, there's also an inflammatory reaction. Histamine, the chemical involved in most allergic reactions, is released in the skin, along with other inflammatory substances. Blood flow is increased and the skin turns red and warm to the touch. This occurs during sun exposure, but rapidly fades. It then comes back 2 to 6 hours later, with pain, as a sunburn. Typically, it's at its worst about 12 to 24 hours after sun exposure, and the soreness lasts about 3 days. After 4 to 7 days, the outer layers of skin peel off and the redness fades.

Any sunburn is a real burn caused by real heat, delivered over time in tiny packets too small to notice. With extremely high doses, sunburn can result in second-degree burns, with severe blistering of the skin, dehydration, fever, and nausea.

Actinic keratosis (AK) is a rough, scaly skin lesion that appears on sun-exposed areas of the skin. AKs are caused by exposure to UV light. They are not cancerous, but may lead to skin cancer if not treated. AKs may have as the same colour as the surrounding skin, or they may look brown, pink, or red.

Making the Diagnosis

People experiencing sunburn often have skin that is red, swollen, or sore to touch. Have a doctor or health care professional look at the sunburn if you notice a rash, itching or fever, or if blisters appear. Darker skin tones may not appear red; however, people with dark skin can still get a sunburn.

Treatment and Prevention

There's no quick fix for sunburn. Like any burn, it takes time to heal. ASA*, cold water compresses, and baths can help with symptoms. Skin hydrating and moisturizing creams may also temporarily remove pain. Many people believe these can also reduce eventual peeling, but this isn't proven. Butter, an old sunburn remedy, is inappropriate as it increases the risk of infection. Soap should be kept clear of burned areas as it's an irritant. Anaesthetic sprays or creams should also be avoided unless recommended by a doctor.

In extreme cases, with blistering and large areas of second-degree burns, the sunburn victim is admitted to a burn unit. Treatment is identical to that received by other burn patients, including steroids and fluid replacement.

The best advice for sunburn is to avoid it completely. The recommendations given by public health experts on sun exposure generally consist of this:

Avoid the sun completely between 10 am and 2 pm when the UV flux is greatest: 65% of all UV hits the Earth during these hours.

Wear sunblock of SPF factor 15 or higher whenever you are outdoors, and reapply it every 2 hours.

Don't just worry about the sun in summer as UV is a year-round problem. Snow reflects 80% of UV light, compared to only 20% by sand - that's why skiers get sunburn.

If you notice any skin changes, including new growths or moles, see your doctor.

In spite of what is known about the risks of sunburn, many Canadians still prefer the look of a "healthy" tan. However, many self-tanning products are available today that produce a healthy tan without the damaging effects of UV rays.

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*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.